CPT code 86738: Mycoplasma antibody, mycoplasma-specific serology2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Mycoplasma antibody analysis measures the patient's antibody response to Mycoplasma and is reported when this organism-specific serologic test is performed.
Medicare pays $13.24 for 86738 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$13.24
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 7 sections
What 86738 covers
This laboratory service analyzes a patient's antibodies to Mycoplasma, a bacterium. A clinical laboratory reports the result of the organism-specific antibody analysis when a clinician orders this test. The code identifies Mycoplasma as the antibody target, distinguishing it from antibody tests directed at other organisms, such as Legionella or influenza virus. It describes serologic analysis, not direct detection of the bacterium.
Report 86738 for the Mycoplasma antibody analysis performed, rather than codes for antibody tests against other named organisms. Medicare pays this laboratory service under the CLFS using one national amount in every state and locality; the amount does not vary by office or facility setting. The 2026 national CLFS amount is $13.24, unchanged from 2020 through 2026. The test is excluded from the physician fee schedule and is paid through the CLFS.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 86738
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 86738. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 86738 with status X (excluded by statute), so the test itself is paid only from the CLFS.
86738 on the lab fee schedule since 2020
86738 · CLFS 2026 Q4 (current)
$13.24
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
86738 compared with similar tests
- 86713Legionella antibody$15.30
- 86713 identifies Legionella antibody analysis. Select the code according to the organism targeted by the serologic test.
- 86710Influenza antibodySerologic testing$13.55
- 86710 identifies influenza-virus antibody analysis; 86738 identifies Mycoplasma antibody analysis.
- 86756RSV antibodySerologic testing$15.89
- 86756 identifies respiratory-virus antibody analysis. Use 86738 when the antibody target is Mycoplasma.
86738 billing questions
What service does 86738 identify?
It identifies laboratory analysis of antibodies to Mycoplasma. It describes antibody analysis, not direct detection of the bacterium.
How does 86738 differ from 86713?
86738 targets Mycoplasma antibodies; 86713 targets Legionella antibodies. Select the code for the organism targeted by the analysis.
Does 86738 represent direct detection of Mycoplasma?
No. It represents analysis of antibodies to Mycoplasma, rather than direct detection of the organism.
What should the documentation support?
The record should support that Mycoplasma antibody analysis was ordered and performed.
How does Medicare pay this test?
Medicare pays it through the CLFS using one national amount across states and localities, with no office or facility difference.
Is there a separate physician-fee-schedule payment?
No. The test is excluded from the physician fee schedule and is paid through the CLFS.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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